Friday, July 28, 2017

Why McCain Might Not Really Have Been a Hero on the Health Care Bill

by Neil H. Buchanan

The Republicans have reached what we can only hope is truly and finally the end of the road for their obsession with repealing the Affordable Care Act. The process was indescribably insane, especially in the last week or so, with a series of bizarre show votes that ultimately led to the Republicans' defeat.

Maybe it really is over, but we thought the same thing two
weeks ago, only to watch things become even weirder. Nothing would
surprise me at this point. We might never hear about health care
legislation again, or we could within days or even minutes discover that
the game is back on.

In any event, the key vote in that please-let-it-be-final showdown was cast by Senator John McCain. Is that vote proof that, at long last, he truly is the principled maverick that he has long portrayed himself to be? Perhaps, but I think that there is a better, more cynical explanation. But first, we need to figure out what McCain's colleagues were thinking during this never-ending farce.

To me, the most interesting question for months has been what the key Republicans -- Donald Trump, Mitch McConnell, Paul Ryan, and others -- were trying to accomplish. What are (or, if this is truly over, were) they thinking? There simply seemed to be no upside to engaging in this fight, especially given that it was taking so much time.

Back in April, I began a column with this question: "Why should Donald Trump bother trying to do anything during his presidency?" I suggested that Trump could enjoy his presidency by being a figurehead who did nothing, sitting back and complaining that nothing was getting done and agreeing to things that Republicans were able to do in spite of Trump's disengagement and incompetence.

In the months since I wrote that column, it became clear that Trump did care about repealing the ACA, but not because he had a better idea or anything positive that he wanted to accomplish. The accomplishment would simply lie in slaying a dragon that he had chased around for the last few years.

But again, why is his hatred of the ACA worth risking this kind of spectacular defeat, when he has been perfectly happy mostly to ignore his other campaign themes? He burbles every now and then about his stupid wall, he tweets about Hillary Clinton being a criminal whenever it suits him, and he seems unable to decide what to do about international trade. Meanwhile, his executive powers are sufficient to impose serious (but mostly under the radar) harm on potential immigrants and refugees.

Why is the ACA different for Trump? And why are almost all congressional Republicans apparently even more obsessed with its repeal? Yes, I know that "the base" is obsessed with the ACA, too, but there is no evidence that they care more about that issue than immigration, Clinton, or trade. Yet we have McConnell and others degrading their institutions in a futile effort to harm tens of millions of people.

It could be that this is one of those self-reinforcing disasters, where no one was able to pull away and take a broader look at what has been happening as they were pulled along by the torrent of events. In fact, however, the news two weeks ago was filled with the idea that the Republicans had reached the end of the road, and people on both sides genuinely seemed to think that there was no way to go forward.

That was a moment when Republicans could have taken a breath and thought about the three possible scenarios that might play out:

(1) Let it go. Moving onto other issues was the most viable option. Everyone was already exhausted by the process, and it was clear that the public hated the Republicans' bill. Although the process to that point had already created plenty of fodder for Democrats' attack ads in 2018, the potential potency of those attacks would be dulled by time.

(2) Try again and fail quickly. This was the "satisfy the
base" fallback strategy, in which Republicans could go back to giving
everyone in their caucus the chance to vote against the ACA, safe in the
knowledge that a few grownups in the Senate would make it all moot.

Importantly, this would again have put it all behind them as soon as
possible, allowing them to move onto the other noxious items on their agenda, such as tax cuts to help rich people, budget cuts to harm everyone else, and fighting with each other about the debt ceiling.

(3) Try again and actually succeed. In this case, the Republicans would have passed a terrible bill on which they and their president had expended enormous amounts of political capital. Only Republicans from the safest of seats (House and Senate) would be unaffected by this.

As a matter of political strategy, it seemed obvious that Option 1 was the best for Republicans. Everyone could continue to live in denial and claim that a handful of traitors had ruined a perfectly good repeal-and-replace strategy.

Instead, out of nowhere, McConnell decided to try again -- but to use a garish process that would become its own negative story line. Moreover, that process would only work by having the health care debate drag on and on, crowding everything else off the agenda.

When it came to the final stratagem, the so-called skinny repeal, everyone -- even those who voted for that bill -- admitted that they were engaged in a massive fraud. The idea was not really to pass that bill but to have the process play out even longer. As a news item in The Washington Post put it:

"It would buy the Senate’s GOP leaders more time, because its passage would lead to a conference committee with the House.

"Negotiations
between lawmakers of the two chambers could then continue past
Congress’s August recess, preserving the ability of McConnell and other
GOP leaders to keep searching for a health-policy formulation that could
garner the support of enough members of their caucus."

That bill died, however, because of a lack of trust between House and Senate Republicans, not because of a principled rejection of the substance of the Republicans' efforts to take away health care from millions upon millions of Americans.

Reporting in the immediate aftermath of the 2am vote, in which McCain joined Susan Collins and Lisa Murkowski (and all 48 Democrats) to defeat the bill, Robert Pear and Thomas Kaplan in The New York Timesdescribed what can only be thought of as a "trust game," where it turned out that none of the Republicans could trust the others enough to move forward.

Remember, Senate Republicans wanted to pass a terrible bill simply to open negotiations with the House. In some sense, this is not as cynical as it might seem, because even in normal times, everyone knows that the bills passed by the two chambers will be renegotiated in reconciliation. Why not simply admit that out loud and let the negotiators go to work?

The not-completely-cynical answers were that the committee would be too secretive and that the result would be presented to wavering not-completely-hard-right Republicans (Dean Heller, Shelley Moore Capito, and so on) as a do-or-die act of party loyalty. Neither of those problems, however, would seem to be enough to get someone like McCain to balk at passing the bill now.

The real issue was apparently that McCain and a few other senators, including Ron Johnson and McCain's Mini-Me Lindsey Graham, demanded guarantees that the Republicans in the House would not simply vote on the Senate's terrible bill -- which the House could do at any time, because the bill would have already passed the Senate, allowing the bill then to go to Trump, whose "pen is ready."

House leaders' words and actions, however, fell decidedly short of ironclad guarantees. Left with the possibility that what was supposed to be simply an empty parliamentary vehicle could actually become law, the senators who did not want that to happen had every reason to vote no.

Yet only McCain voted no, while Graham and everyone else who had expressed reservations voted yes. Forgive my deep cynicism, but this reeks of political theater.

In what might initially appear to be very bad timing, Paul Krugman's op-ed in Friday's Times -- which was written before the final Senate vote but was published a few hours afterward -- described "the awfulness of John McCain." This is at odds with never-Trump conservative writer Jennifer Rubin's very defensible (but I think incorrect) description of McCain as a hero for voting against the bill.

But as Krugman pointed out, McCain had voted to allow this entire circus of a process to begin, even though his vote could have averted the 50-50 tie that Vice President Pence broke several days before. McCain then voted in favor of a version of the bill that he had said he would not support.

As long as we are in full-on cynical mode, however, it is worth pointing out that the vote that made McCain look like a hypocrite was not a tie-averting vote, because that bill was going down easily. So even though McCain voted in a way that he had promised not to, he did so knowing that it did not matter. Cynicism thus becomes evidence of possible underlying virtue.

Remember, however, that Graham and others agreed with McCain that it would be just fine for the bill to go to conference, and potentially for the conference committee to come up with a combination of the original House and Senate bills that might be even more awful. But now that we are thinking in double-reverse strategic terms, maybe McCain and his group were hoping that the bill would die in committee, such that their votes to push the bill out of the Senate were not really and truly votes to take away health care from non-rich people.

In any case, we know that McCain and his cohort were not against the Republicans' basic approach to repealing the ACA. They were simply worried about House Republicans double-crossing them. If that is the explanation, however, then we have to ask why it was McCain, and McCain alone, who cast the key vote.

Based on their stated rationales, after all, several Republican senators could simply have said, "We know that this might be the last stand for the repeal-and-replace effort, but House leaders have not given us the guarantees that we demand, so we vote no." McCain could have been among that group, but he need not have been alone.

If no explanation is too cynical, and I think we are clearly operating in an environment where every possibility has to be on the table, we can try this one on for size:

Graham and the others knew that only one of them needed to vote no (given that Collins and Murkowski were solid). Voting yes shielded each of them from abuse by Trump and his mobocracy. Voting no -- especially doing so alone -- would thus seem to be a risky and brave move.

Whose "brand" is all about bravery? Who would like nothing better than to be seen standing alone (not really, given Collins and Murkowski, but it is already being spun that way), especially in order to be viewed as finally facing down the man who disparaged his personal history of (very real) bravery and heroism?

In short, we have a process that could easily have been manipulated to allow McCain to emerge as the last-minute hero, gladdening the hearts of moderates and liberals so much that they would say: "Wow, the guy really came through when it counted -- and even after brain surgery!"

Is this explanation cynical? Of course. Too cynical? I think not. In the end, McCain joined fifty other people to vote against something terrible, but he did not even do so on the merits. We can be happy with the outcome without being deceived by the political posturing.

All of this is reasonable enough. I think it is somewhat of a thought exercise and there is no grand reason to praise McCain too much here given his long term actions.

But, for whatever reason, he did vote the right way. That's appreciated. Sometimes, you win by using the other side's less than heroic characteristics, including the desire to look mavericky. And, I think McCain did find the whole thing bad while also caring about other things like defense, so very welcome to getting it out of the way.

Anyway, the stay of execution here was very important, but the people in control still have many ways to hurt ACA. A major place there is behind the scenes at the HHS, from Thomas E. Price on down.

Mr. Buchanan’s analysis is almost certainly the correct one, invoking Occam’s Razor once again. But it may be that the conspirators were more than just McCain, Graham and Johnson.

McCain was drafted, or more likely volunteered ‘to take one for the team’. This team was comprised of those Senators who were both appalled by the provisions of the ‘skinny’ repeal and did not trust Paul Ryan (cannot quarrel with that) and appalled by the process and wanted to vote no. They included not only the three who spoke out, but also some or all of the following; Portman, Capito, Heller, Flake, the two Tennessee senators and probably a couple of others that we don’t know about, along with conservatives like Rand Paul, Jerry Moran, Mike Lee et al who wanted to make a statement that they were only in favor of full repeal.

Being a military man the McCain let the word go out, in great subtlety of course, that casualties could be minimized, that three votes against skinny had the same impact as ten votes against skinny. So the tacit agreement was that McCain was the politician who could best withstand a hit and once he signaled he was a no vote the rest felt safe in voting yes. Mr. Buchanan’s argument of cynicism is right, but if this is the event that kills repeal for the foreseeable future then we will take the result, however cynically it was achieved.

Sometimes McCain can be McAble. In my view McCain's action was coordinated beyond Senators Graham and Johnson, perhaps as many as 6 or 7 more Republican Senators, in an effort to prevent a disaster in the 2018 elections. And McConnell may have had advance knowledge of the plan. McCain was the logical choice to protect the Republican brand as he had been recently reelected and his medical condition could apply the maverick cover. A goal was to prevent a humiliating defeat for McConnell and the Republican brand via 7-10 defecting Republican Senators.

I noted David Brooks' NYTimes column today on AZ Sen. Flake and his new book. Flake may have been part of the cabal as the column seemed to suggest Flake as openly anti-Trump. The close defeat permits members of the McCain cabal to claim party loyalty as 2018 elections near, with opportunities in the interim for the Republican Party to bett plan for elections by separating themselves from Trump as Trump might self-destruct.

The big question is how Democrats react in Congress regarding making Obamacare better and how Republicans respond.

While Dems will try to make Obamacare better, there is little chance anything they propose will be able to pass Congress. If Republicans were willing to take 20 to 25 million off of health insurance for ideological reasons then having large increases in premiums for unsubsidized people and a few areas with no private insurance providers is not going to bother them in the least. They may even welcome that happening; having less people covered seems to have been one of their goals.

So the real question is what will the administration do,

1. Enforce or not enforce the mandates?2. Pay or not pay the cost reduction monies due insurers?3. Promote or not promote enrollment (earlier this year they pulled advertisements that had already been paid for)?4. Use regulatory discretion to grant waivers and other actions to eliminate EHCB and other provisions?

The ball is in Trump's court, but then as Scaramucci has said Donnie can swish shots from the foul line while still wearing his overcoat.

If Democrats want to make PPACA better, I suggest to avoid connecting it to Obama, including the usage of "Obamacare."

There might be some value in tying it to Obama in some cases, since he's popular, especially now with Trump there. OTOH, tying it to a specific partisan figure, a time based one too, is has problems. The matter is bigger than one person. In practice, Democrats have a reason to own this issue. But, the overall aspects need to be seen as general goods. "Obamacare" hurts the cause in my eyes. Also, it sounds like "Medicare," which is a broader program especially with state ability now to refuse Medicaid expansion. Again, perhaps that can be used to our advantage, but it is part of why I don't like the term.

The ACA was pejoratively characterized as Obamacare by Republicans But over the years, the ACA gained some popularity and finally enough acceptance that all the Trump's Republicans controlling the Executive and Legislative Branches could not repeal and/or replace Obamacare. The course the Republicans had taken with Obamacare was similar to early efforts to undo Social Security, which benefited Democrats over several decades. Then there was Medicare. FDR's name was not made part of Social Security nor was LBJ's name made part of Medicare. But history helps us to remember the roles of FDR with Social Security and of LBJ with Medicare. So I have no problem with Democrats dropping references to Obamacare as history will help us to remember Obama's role with ACA, even as it may be improved by amendment, including in the form of single-payer, universal coverage. Why even include in such improvements a specific provision negating reference to the term Obamacare, even criminally if that could pass constitutional muster. Whatever it's called, history will inform us. Imagine if President Trump had come up with a better plan, with better and cheaper coverage, for everyone, as he promised. Why that could have been referenced as Trumpcare. That might have stolen some of Obama's thunder, but history would not forget Obama's role even in that event.

BTW, Abbe Gluck has an interesting post at Balkinization on the concept of ACA as a "super-bill." [He's working on an article with more detail to be published via SSRN.]